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Session 28, February 12, 2019
Bringing Digital to Life
Neil Gomes Chief Digital Officer and Executive Vice President
Maia Ottenstein Digital Experience Design Lead for UX Research
The DICE Group at Thomas Jefferson University and Jefferson Health
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CONFLICT OF INTEREST
Neil Gomes, MBA, M.Ed., CSM, CSPO
Executive Vice President and Chief Digital Officer
Has no real or apparent conflicts of interest to report.
Maia Ottenstein
Digital Experience Design Lead for UX Research
Has no real or apparent conflicts of interest to report.
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Understanding the patient journey
How to identify pain points
Identifying and addressing opportunities for innovation
How Jefferson Health addresses problems in healthcare through
The DICE Group
Three examples of how we are transforming the
patient journey
The impact of design solutions on the overall
healthcare journey
AGENDA
4
Identify the current state of a healthcare consumer journey and how digital
platforms and solutions can enhance these journeys and make them more
meaningful.
Illustrate opportunities for innovative change within which health systems can
provide better care.
Share how innovative solutions have transformed our consumer journey.
Demonstrate the advantages of gaining consumer trust and support from a
business perspective.
LEARNING OBJECTIVES
5
EXISTING APPROACHES
TO IMPACTING
THE PATIENT JOURNEY
6
WHAT MOST PEOPLE THINK OF WHEN THEY
HEAR “PATIENT JOURNEY
GO HOMEMEET WITH DOCTORMAKE APPOINTMENT
EXPERIENCE SYMPTOMS
ACTION
Recognize something is
wrong.
Decide the symptoms are
worthy of a doctor’s visit,
call a primary care
provider’s office.
Meet with the doctor.
Review symptoms,
feedback, and
recommendations with
doctor.
Go home, follow doctor’s
recommendations, and
feel better.
EXPECTATIONS
7
EXISTING SOLUTIONS
(AND WHY THEY ARENT ENOUGH)
GO HOMEMEET WITH DOCTORMAKE APPOINTMENT
EXPERIENCE SYMPTOMS
Recognize something is
wrong.
Decide the symptoms are
worthy of a doctor’s visit,
call a primary care
provider’s office.
Meet with the doctor.
Review symptoms,
feedback, and
recommendations with
doctor.
Go home, follow doctor’s
recommendations, and
feel better.
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OUR APPROACH
TO IMPROVING
THE PATIENT JOURNEY
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An Identity Crisis?
?
Healthcare &
Education
?
Design
Tech
…Not Really
More of an Existential Crisis
+
+
10
IDENTIFY NEEDS & OPPORTUNITIES
DIGITAL
SOLUTIONS
JEFFERSON
CONSUMER
11
18
HOSPITALS
6.1B
+
REVENUE
34
+
OUTPATIENT &
URGENT CARES
$218M
IN CHARITABLE
CARE
15
COLLEGES
6000
+
NURSES
5K
+
PHYSICIANS
100K
ADMISSIONS
3600
+
FACULTY
12
Closed-loop Digital
Experiences
EXPERIENCE
Services via Web, Mobile,
Wearables, IoT, etc.
CONVENIENCE
Ease of Access to
Jefferson Services
ACCESS
CARE, LEARNING, WORK, RESEARCH, GIVING…
C O N S U M E R = P A T I E N T S , S T U D E N T S , S T A F F , D O N O R S H U M A N S
…LIKE EVERYTHING ELSE DIGITAL
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myBaby
@Jeff
myJeffHealth Strength
Thought Insight
Leadership
Rounding
Dashboards
JeffBNB JeffDocs
JTOG
150
+
TEAM
130
+
PROJECTS
10
X
RETURNS
THE DICE GROUP AT JEFFERSON
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THE NEED FOR
THOUGHTFUL AND THOROUGH
SERVICE DESIGN
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UPGRADE YOUR PATIENTS’ EXPERIENCE
Caring about your patients makes the difference between their
potential anguish and their potential delight.
17
GROWING DEMAND FOR SERVICE DESIGN IN
HEALTHCARE
32.51%
Consumers said in 2016 that patient ratings
are the most important information when
choosing a hospital.
1
80%
Of patients reported they would switch providers
for convenience factors alone.
2
1. https://nrchealth.com/2016-us-health-care-statistics-data-state-demographics/
2. https://nrchealth.com/wp-content/uploads/2018/12/2019-Healthcare-Consumer-Trends-Report.pdf
“Organizations need to adjust away from
an episodic model, and toward
continuous relationship cultivation.
2
“While patients praise their doctors and
nurses, they’re far less likely to rave
about their broader service
experiences.
2
- NRC 2019 Healthcare Consumer Trends
Report
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WAIT FOR APPOITNTMENT, SELF
MANAGE SYMPTOMS
SCHEDULE
APPOINTMENT
COMMON PATIENT JOURNEY
FIND DOCTOR
SELF MANAGE
SYMPTOMS
EXPERIENCE
SYMPTOMS
“I was concerned but I
thought it might go away
on its own.”
“When I realized something
was really wrong I did some
research on the internet to
see what it might be. It
seemed like I could handle it
myself…”
”My doctor recommended
the specialist so I just
called them. I didn’t think
twice about it.”
“It was just kind of a ‘grin
and bear it’ situation. I
wasn’t upset. I figured I
could wait.”
ACTION
Notice something is
wrong or experience
health issue.
Try to handle the situation
without seeking medical
advice. Check symptoms
and care
Many patients interviewed
start by going to a PCP
with which they have an
established relationship.
Most patients chose to call
to schedule appointments.
Some patients noted that
they prefer they ability to
schedule online.
Most patients waited for 2
weeks to 2 months for their
appointment. None were given
instructions for how to manage
symptoms in the meantime.
Symptoms will go away
without medical advice
or intervention.
Symptoms will be
treatable at home without
medical advice.
All patients interviewed
followed
recommendations for
specialists from
another physician.
Understand availability
may be limited but
hope for an
appointment in the
near future.
EXPECTATIONS
Time between the call and the
actual appointment will be
difficult and painful.
“I was taking care of it. I was
definitely concerned, but it seemed
like there was nothing else I could
do.”
THOUGHTS/
FEELINGS
WHAT HAPPENED?
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CHECK OUT
DISCHARGE
INSTRUCTIONS
APPOINTMENT
CHECK IN
AND WAIT
GO TO APPOINTMENT
THOUGHTS/
FEELINGS
“I went to one part of the office,
saw a sign that seemed to
indicate I needed to go to the
other side, and then was told to
return to the first location.”
“...it was overwhelming. I had
never been to a doctor like this
before so I [hoped] the set up
was normal for a place like this.”
“They took me back quickly but
then I waited for40 minutes.”
“I love my doctor, I’ve been seeing
her for years. We have a great
relationship.”
“We asked the same questions
every time... I guess they weren’t
being clear.”
“I was overwhelmed. I felt like
they wanted me to make really
big decisions really quickly”
C O N TINU E D
WHAT HAPPENED?
Patients reported little
trouble finding the doctor’s
office. Observations show a
great deal of confusion,
especially for initial visits.
Patient checks in with
desk staff, fills out
necessary paperwork,
and waits to be called
back.
Brought to an exam room.
Vitals taken, questions asked.
Patient waits alone for
doctor. Doctor comes in and
examines patient.
Patients experienced
trouble communicating
well with their physicians
and getting feedback in a
meaningful way.
Patient goes to check out
counter to pay for the
appointment. Sometimes
they also receive
prescriptions at this time.
EXPECTATIONS
Doctor’s office locations
will be easy to navigate
to and from.
Easy check in and
relatively short wait.
See the doctor quickly, in
and out.
Doctor gives details
about patient’s next
steps and what to expect
from their medical
condition.
Pay for appointment at
reasonable cost and
schedule follow up.
“I’m relieved I have
insurance.”
“I don’t understand how
such a short visit can cost so
much money.”
COMMON PATIENT JOURNEY
ACTION
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SYMPTOM
RELIEF
ACTION
FOLLOW UP
CARE
COMMUNICATION
WITH DOCTOR
FOLLOW UP CARE
PRESCRIPTION
PICK UP
Pharmacy did not have
medication and patient
had to wait or make a
second trip.
Symptoms persisted. Unsure of
if they were doing things
correctly. Did not have a good
understanding of what would
happen.
Doctor was impossible to
get hold of.
For some, symptoms
persisted and the patient
was confused and scared.
For others, symptoms
began to improve.
”I didn’t have any problems.”
“Sometimes I have to wait but
my pharmacy is pretty
reliable.”
“I didn’t feel better. I wondered
if I was doing something wrong.
Maybe I missed something they
said. It made me nervous.”
“Even contact through
MyChart was not helpful. I
had to send multiple
messages over the course of
weeks to get a response.”
“It was frustrating. It felt like I
was stuck and I might never
feel better.”
“Once I started feeling better I
had hope that this would be
over soon.”
Go to pharmacy and get
medication.
Care will be manageable. Doctor would be
responsive, if not over
the phone at least
through email.
Relief from symptoms. Symptoms are gone and
patient moves on.
”It’s incredible. I forgot what it
was like to not be in pain.”
C O N TINU E D
COMMON PATIENT JOURNEY
THOUGHTS/
FEELINGS
WHAT HAPPENED?
EXPECTATIONS
Symptoms were relieved, acted
upon, or temporarily improved.
Patients whose symptoms
persisted were very uneasy.
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HOW TO IDENTIFY PAIN POINTS
FOCUS ON THE EMOTIONAL JOURNEY
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IDENTIFYING OPPORTUNITIES
Understand your patients’
ideal health care
experiences.
What do they need that
they may not even know
they can ask for?
ACTION
CHECK IN
AND WAIT
GO TO
APPOINTMENT
THOUGHTS/
FEELINGS
“I went to one part of the office,
saw a sign that seemed to
indicate I needed to go to the
other side, and then was told to
return to the first location.”
“...it was overwhelming. I had
never been to a doctor like this
before so I [hoped] the set up
was normal for a place like this.”
WHAT HAPPENED?
Patients reported little
trouble finding the doctor’s
office. Observations show a
great deal of confusion,
especially for initial visits.
Patient checks in with
desk staff, fills out
necessary paperwork,
and waits to be called
back.
EXPECTATIONS
Doctor’s office locations
will be easy to navigate
to and from.
Easy check in and
relatively short wait.
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“there is a big technological gap between how
patients interact with their doctor's offices, and how
they manage the rest of their lives…”
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HOW A DESIGN MINDSET CAN CHANGE THE PATIENT
JOURNEY
6. https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.htm
10. https://www.cdc.gov/pcd/issues/2018/18_0128.htm l
“Health care systems require continuous innovation… However…
stakeholders are not always considered when new interventions or system
processes are designed, which results in products that remain unused
because they do not account for human context, need, or fallibility…”
CDC, Preventing Chronic Disease, 27 September 2018
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CASE STUDY 1:
SHUTTLE TRACKER
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CASE STUDY 1: SHUTTLE TRACKER
Jefferson Health’s Center City campus in
Philadelphia is comprised of 12 buildings
spread across 5 square city blocks
(0.3 square miles).
7%
Adults unable to walk
0.25 miles
3
16.1%
Adults who have difficulty with any
physical functioning
3
3,700,000
Jefferson Health
outpatients in 2018.
GO TO APPOINTMENT
Patients reported little trouble
finding the doctor’s office.
Observations show a great deal
of confusion, especially for
initial visits.
“I went to one part of the office,
saw a sign that seemed to
indicate I needed to go to the
other side, and then was told to
return to the first location.”
3. https://www.cdc.gov/nchs/fastats/disability.htm
4. https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html
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CASE STUDY 1: SHUTTLE TRACKER PROBLEM
Many patients and patrons of
Jefferson Health
were not aware of the
campus shuttle.
Because there is no set
schedule, patients and visitors
using the shuttle were forced
to wait
outside without any idea
of when the shuttle
would arrive next.
Drivers expect riders to know
when to be outside, and to be
there waiting. They will not
stop if they do not see
someone waiting for the
shuttle.
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CASE STUDY 1: SHUTTLE TRACKER SOLUTION
Mobile view Desktop view
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CASE STUDY 1: SHUTTLE TRACKER IMPACT
66.67%
Based on our most recent data, ridership
has increased by at least
The success and popularity of our Center City project has created demand for
shuttle trackers for all other Jefferson campus shuttles.
“We don’t have a tracker for this route. If I had
known when the bus would come, I would have
stayed on the clock for 10 more minutes.”
-Rider, Methodist Route
“Once I put the signs out, riders know that the
bus is running, and that I’ll be there soon.”
- Clyde, Morning Driver for Center City Route
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CASE STUDY 1: SHUTTLE TRACKER IMPACT
“I use the tracker every day so that
I don’t have to wait outside.”
-Rider, Center City Loop
GO TO APPOINTMENT
Patients feel supported by their
healthcare system and appreciate the
extra mile to make going to the doctors
office that much more accessible of a
journey.
GO TO APPOINTMENT
Patients reported little trouble
finding the doctor’s office.
Observations show a great deal
of confusion, especially for
initial visits.
“I went to one part of the
office, saw a sign that seemed
to indicate I needed to go to
the other side, and then was
told to return to the first
location.”
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CASE STUDY 2:
KNOCK, SIT, ASK
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CASE STUDY 2: KNOCK, SIT, ASK PROBLEM
“physicians don’t have the support they need to sustain good patient
communication skills…”
9
a positive doctor-patient relationship can have statistically significant effects on
‘hard health outcomes’…”
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8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/
9. https://health.usnews.com/health-news/patient-advice/articles/2015/04/20/why-nice-doctors-are-better-doctors
“Doctors tend to overestimate their abilities in communication…
75% of the orthopedic surgeons surveyed believed that they
communicated satisfactorily… but only 21% of the patients reported
satisfactory communication with their doctors.
8
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CASE STUDY 2: KNOCK, SIT, ASK PROBLEM
APPOINTMENT
“They took me back quickly
but then I waited for40
minutes.”
“I love my doctor, I’ve been
seeing her for years. We
have a great relationship.”
Brought to an exam room.
Vitals taken, questions
asked. Patient waits alone
for doctor. Doctor comes in
and examines patient.
"It's really frustrating here... I
don't understand why they
are keeping me here. I could
be just sitting here at home.
I'm confused and
overwhelmed. I don't know
what's going on! All these
tests…"
-Patient in ACE unit at
Methodist Hospital
DISCHARGE
INSTRUCTIONS
“We asked the same
questions every time... I guess
they weren’t being clear.”
“I was overwhelmed. I felt like
they wanted me to make
really big decisions really
quickly”
Patients experienced
trouble communicating well
with their physicians and
getting feedback in a
meaningful way.
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CASE STUDY 2: KNOCK, SIT, ASK SOLUTION
What Medical Questio
n
s Can
To You and Your Loved Ones,
We Answer?
What Medical Questio
n
s Can
To You and Your Loved Ones,
We Answer?
34
CASE STUDY 2: KNOCK, SIT, ASK IMPACT
Press Ganey scores in the ACE Unit at Methodist Hospital have
increased since implementation…
Communication with Doctors
Discharge Information
Physician Scores
35
CASE STUDY 2: KNOCK, SIT, ASK IMPACT
APPOINTMENT
“They took me back quickly
but then I waited for 40
minutes.”
“I love my doctor, I’ve been
seeing her for years. We
have a great relationship.”
Brought to an exam room.
Vitals taken, questions
asked. Patient waits alone
for doctor. Doctor comes in
and examines patient.
DISCHARGE
INSTRUCTIONS
“We asked the same
questions every time... I guess
they weren’t being clear.”
“I was overwhelmed. I felt like
they wanted me to make
really big decisions really
quickly”
Patients experienced
trouble communicating well
with their physicians and
getting feedback in a
meaningful way.
36
CASE STUDY 2: KNOCK, SIT, ASK IMPACT
APPOINTMENT
“My wife has been in and out of
the hospital for years...We
would do something like this.
We did forget a lot of our
questions. And I always missed
the doc [checking in].”
-Patient in ACE Unit at
Methodist Hospital
Patient is able to have a
meaningful conversation
with the doctor in which
every question they have is
addressed and answered
clearly.
DISCHARGE
INSTRUCTIONS
“My daughter handles all my
healthcare issues…. This looks
like something she would
use… she would like to see
it.”
-Patient in ACE Unit at
Methodist Hospital
Patients understand how to
continue treatment and
what to expect moving
forward.
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CASE STUDY 3:
SKCC KIOSKS
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FOLLOW UP CARE
Symptoms persisted.
Unsure of if they were
doing things correctly.
Did not have a good
understanding of what
would happen.
“I didn’t feel better. I
wondered if I was doing
something wrong.
Maybe I missed
something they said. It
made me nervous.”
CASE STUDY 3: SKCC KIOSKS PROBLEM
CHECK IN AND WAIT
“...it was overwhelming. I
had never been to a doctor
like this before so I [hoped]
the set up was normal for a
place like this.”
Patient checks in with desk
staff, fills out necessary
paperwork, and waits to be
called back.
63%
“Patients said that the most
stressful thing about going to
their MD was waiting.
6”
6. https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.html
Questions - “What can I bring?”, “Is
this working?”
Emotions Depression, Guilt,
Weakness, Isolation
Questions -
Emotions Relief, Lost, Paranoia,
Worry
Questions – “What symptoms
should I look for now?”, “Will it
come back?”
Emotions Triumph, Relief, Worry,
Paranoia
Remission
Treatment
Recurrence
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CASE STUDY 3: SKCC KIOSKS SOLUTION
Kiosk home screen Event detail screen Event registration confirmation
40
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Before Oct. 2018
Patient awareness of opportunities for
learning, support, and other events were
minimal.
Oct. 1, 2018 Jan. 2, 2019
237 interactions with our kiosks.
Event registrations increased by 16.69%
“People really like the convenience of it.
They can register for more than one event
at a time…”
-Employee at the SKCC Welcome Center
CASE STUDY 3: SKCC KIOSKS IMPACT
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FOLLOW UP CARE
Symptoms persisted.
Unsure of if they were
doing things correctly.
Did not have a good
understanding of what
would happen.
“I didn’t feel better. I
wondered if I was doing
something wrong. Maybe
I missed something they
said. It made me
nervous.”
CASE STUDY 3: SKCC KIOSKS IMPACT
CHECK IN AND WAIT
“...it was overwhelming. I
had never been to a
doctor like this before so I
[hoped] the set up was
normal for a place like
this.”
Patient checks in with
desk staff, fills out
necessary paperwork, and
waits to be called back.
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Realistic expectations for
long term care. Continuous
support and education from
healthcare institution
throughout treatment
journey.
“[The events that SKCC
offers] improve patients’
recovery and emotional
wellbeing.”
-Researcher for Palliative
Care at Jefferson Health
FOLLOW UP CARE
CASE STUDY 3: SKCC KIOSKS IMPACT
CHECK IN AND WAIT
“We encourage people to
come here and they’re
always glad when they
do.”
-Employee at SKCC
Welcome Center
Check in and peruse
Kiosks. Learn about events
and support from SKCC
while waiting for
appointment.
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IMPACT OF DESIGN IN HEALTHCARE
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IMPACT OF DICE AT
JEFFERSON HEALTH
1.46M
Raised via online
donation app
7.5M
Saved by staff online
training
10K
+
Physician hours saved
by online training
10K
+
App downloads
1M
+
Yearly saving for
staffing costs in ER
Rating increase in
18 months by
rounding app
CMS
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ORIGINAL PATIENT JOURNEY
47
UPDATED PATIENT JOURNEY
48
Research by AHRQ has proven that increasing patient and family engagement
has a multitude of benefits including:
Improve quality and safety
“patients and families… become allies… through ‘informed choices, safe medication use,
infection control initiatives, observing care processes, reporting complications, and
practicing self-management.’”
5
Improve CAHPS scores
Improve patient outcomes
emotional health, symptom resolution, functioning, pain control, and physiologic
measures such as blood pressure and blood sugar levels.
”5
Increase employee satisfaction and retention
Reduce errors
Improve financial performance
“patient and family engagement consistently predicts hospital performance on an array
of crucial business outcomes’”
5
SERVICE DESIGN FOR HEALTHCARE
BUSINESS CASE
5.https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtogetstarted/How_PFE_Benefits_Hosp_508.pd
f
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Our consumers,
vendors, donors, and
community are our
partners; we develop
synergistic
relationships and grow
together
Great Partners
Innovation must not be
the currency of a few,
but the combined
wealth of many and
platforms can make
this a reality
Great Platforms
From design to
development to support,
inspired, motivated, and
agile teams move us
into the future
Great Teams
TRANSFORMATION
T H E E Q U A T I O N F O R
T RAN S FO R M AT I O N
Great things in business are never done by one
person. They're done by a team of people.
S T E V E J O B S
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Resources
1. https://nrchealth.com/2016-us-health-care-statistics-data-state-demographics/
2. https://nrchealth.com/wp-content/uploads/2018/12/2019-Healthcare-Consumer-Trends-Report.pdf
3. https://www.cdc.gov/nchs/fastats/disability.htm
4. https://www.census.gov/newsroom/facts-for-features/2017/cb17-ff08.html
5. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/howtoget
started/How_PFE_Benefits_Hosp_508.pdf
6. https://www.cnbc.com/2016/04/05/most-stressful-part-of-doctors-visit-the-wait-says-survey.html
7. https://www.ncbi.nlm.nih.gov/pubmed/8953956
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/
9. https://health.usnews.com/health-news/patient-advice/articles/2015/04/20/why-nice-doctors-are-better-
doctors
10. https://www.cdc.gov/pcd/issues/2018/18_0128.htm l
51
Neil Gomes, MBA, M.Ed., CSM, CSPO
Executive Vice President and Chief Digital Officer
Linkedin.com/in/neilgomes
Twitter: @neilgomes
Maia Ottenstein
Digital Experience Design Lead for UX Research
Linkedin.com/in/maiao
Email: maia.ottenstein@Jefferson.edu
THANK YOU!